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Aetna Medicare Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Plus (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Plus (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $25.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. In the initial coverage phase, after you pay the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail, but a $12 copay at standard pharmacies and standard mail. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance depending on the drug tier. After your total yearly drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Plus (HMO-POS) plan offers a wide array of benefits with varying cost-sharing. Inpatient hospital stays have a $100 copay for days 1-5, and no copay for days 6-90. Outpatient services generally have no copay, but some may have a copay up to $100. The plan also includes coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, dental, and home health services. Many services have no copay, while others may have a coinsurance or copay. The plan also covers medical equipment, diagnostic services, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient hospital stays are covered, with a $100 copay for days 1-5 and no copay for days 6-90, and inpatient hospital psychiatric stays are covered with a $100 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay of $0-$100, while Observation Services, Ambulatory Surgical Center Services, Individual Sessions for Outpatient Substance Abuse, Group Sessions for Outpatient Substance Abuse, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Plus (HMO-POS) with no copay. Prior authorization is required for coverage of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Plus (HMO-POS), including ground and air ambulance services. Ground ambulance services have a copay of $245, while air ambulance services have a 20% coinsurance; transportation services to plan-approved health-related locations have no copay for up to 12 one-way trips per year, but transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay with no coinsurance, while Worldwide Emergency Transportation has a $245 copay with no coinsurance. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The Aetna Medicare Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have no copay. Additional telehealth benefits have no copay and a 20% coinsurance. The other services have a $0 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with varying copays depending on the service. Kidney disease education services have a 20% coinsurance, and other preventive services have no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a plan-specified amount up to $2000 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Plus (HMO-POS) covers vision services, including eye exams with no copay, and routine eye exams once per year with no copay. Eyewear is also covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Aetna Medicare Plus (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. The plan also offers up to $1,750 per year for other dental services, but does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Plus (HMO-POS) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Plus (HMO-POS). Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, but durable medical equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have no coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests and lab services have no copay, while therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Plus (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Plus (HMO-POS) plan. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Plus (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $100 copay for days 21-100; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services," acupuncture, "Other 1" which includes annual wellness exams and screening mammography, and "Other 2" which includes gFOBT and FIT, are covered with no copay. Over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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